ACEIs/ARBs improved all sexual function domains in hypertensive women; beta-blockers helped less, especially in uncontrolled hypertension (n=125, 3 months)
Journal: Scientific Reports | Published: 2026-03-17 | Type: Randomized Controlled Trial | PMID: 41844720 Authors: GamalEl Din SF, Elyamani E, Bushra MT, Ghaly MF, Ragab MW, Aboseif AF — Departments of Andrology, Cardiology, and Public Health across Cairo University (Kasr Alainy) and Beni-Suef University, Egypt; one author affiliated with Egyptian Ministry of Population and Health Funding/COI: Funding not disclosed. Authors declare no competing interests.
This single-center Egyptian RCT enrolled 125 premenopausal women — 100 hypertensive and 25 normotensive controls — to compare the effects of beta-blockers versus ACEIs/ARBs (with and without added hydrochlorothiazide) on female sexual function over three months. ACEI/ARB users saw significant improvement across all domains of the Arabic Female Sexual Function Index (ArFSFI) regardless of blood pressure control status. Beta-blockers produced similar gains only in women with controlled hypertension; uncontrolled hypertensive women on beta-blockers improved on some domains but not overall score. The authors acknowledge the study is too small and too short to draw firm conclusions.
This is a prospective RCT, which puts it above the observational studies that dominate this literature. Allocation concealment was described as "data sent in closed envelopes opened by an assigned physician," which is at least nominal blinding of allocation. Ethics registration was prospective (Beni-Suef IRB, UMIN000053844). Exclusion criteria were extensive and sensibly applied: diabetes, obesity (BMI ≥ 30), smoking, postmenopause, PCOS, depression, and urinary incontinence were all excluded to reduce confounders.
However, the groups are only n=25 each — the paper's own authors call this out as a limitation. Three months is a short observation window for hormonal and vascular adaptations. The normotensive control group (n=25) was recruited from "healthy females accompanying patients," which is a convenience sample carrying uncontrolled selection bias. Randomization was described as "simple numbering," which is not stratified and risks imbalance in confounders. The study is not blinded — participants and likely assessors knew which drug class was being taken — introducing performance and assessment bias into a subjective outcome (self-reported sexual function). Funding is not disclosed, which is a gap rather than a red flag, but notable for a drug comparison study.
This paper addresses a real and underexplored problem — female sexual dysfunction in hypertensive patients is prevalent and under-researched — but the n=25-per-arm design and absence of blinding mean its findings are hypothesis-generating at best. The headline result (ACEIs/ARBs better than beta-blockers for female sexual function) is plausible and consistent with prior smaller trials cited in the discussion, but this study cannot confirm it. The hormone data (falling testosterone, rising estradiol across all drug groups) muddies rather than clarifies the proposed mechanism. Read it as a feasibility study pointing toward where a properly powered, blinded multicenter trial needs to go. Don't cite the specific effect sizes as established fact.